AHRQ: A Common Ear Surgery For Children Does Not Measurably Improve Development at Age Three

ROCKVILLE, Md., April 18 /PRNewswire/ -- A new study co-sponsored by the
Agency for Healthcare Research and Quality (AHRQ) and the National Institute
of Child Health and Human Development indicates that, in most cases, inserting
tubes in the eardrums -- a procedure called tympanostomy -- of children under
age three years who have fluid in the middle ear has no measurable effect on
improving children's speech, language, cognitive, or psychosocial development
at age three.
"While this study is limited to children age three and under, it clearly
demonstrates the importance of making treatment decisions based on a broad
range of outcomes and quality-of-life measures," said Lisa A. Simpson, M.B.,
B.Ch., M.P.H., AHRQ's deputy director.
Fluid in the middle ear -- otitis media with effusion (OME) -- is usually
associated with a mild to moderate hearing loss, which, although temporary,
has been thought by some health professionals to result in long-term
impairment of children's development. Approximately 280,000 children under
the age of three undergo tympanostomy each year, according to 1996 estimates.
Jack L. Paradise, M.D., and his colleagues at the Children's Hospital of
Pittsburgh and the University of Pittsburgh found that, in 402 of 588 children
in the study who developed persistent OME within the first three years, there
were no differences in the outcomes of speech, language, cognitive, and
psychosocial assessments. This was true for the children who were randomly
assigned to have tympanostomy surgery early as well as those who were assigned
to have the surgery only after their effusion persisted. Most of the children
in the early-surgery group received surgery within 60 days, whereas most in
the late-surgery group either received surgery after more than six months or
had not received surgery by age three. Infants up to two months of age were
enrolled in the study, which was conducted between May 1991 and December 1995.
On the General Cognitive Index of the McCarthy Scales of Children's
Abilities, the children in the early-surgery group tested at 99, and the
children in the late-surgery group tested at 101; both scores are in the
average range. On a test of the children's expressive language, the children
in the early-surgery group scored 124 while the others scored 126, which are
average scores. Other assessments used in the study are measures of receptive
language, sentence length, grammatical complexity, speech-sound production
(pronunciation), parent-child stress levels, and children's behavior. These
measures showed no significant differences between the two groups.
According to the researchers, these findings should not be applied to
children who have experienced OME for longer periods than those studied by the
researchers or to children with more severe degrees of hearing loss. Also,
they cautioned that the results of tests when the children reach ages four and
six years may differ from those found at age three.
In an accompanying editorial, James M. Perrin, M.D., Director, Division of
General Pediatrics and Center for Child and Adolescent Health Policy,
Massachusetts General Hospital for Children, and a member of AHRQ's National
Advisory Council, writes that "the study by Paradise, et. al., provides
evidence to support the use of a cautious approach in referring young children
with middle-ear effusion to receive tympanostomy tubes." He notes that "the
study by Paradise, et. al., provides no evidence that the insertion of tubes
improves developmental outcomes at the age of three years, although it does
decrease the persistence of effusion and reduce short-term hearing loss."

SOURCE Agency for Healthcare Research and Quality

ROCKVILLE, Md., April 18 /PRNewswire/ -- A new study co-sponsored by the
Agency for Healthcare Research and Quality (AHRQ) and the National Institute
of Child Health and Human Development indicates that, in most cases, inserting
tubes in the eardrums -- a procedure called tympanostomy -- of children under
age three years who have fluid in the middle ear has no measurable effect on
improving children's speech, language, cognitive, or psychosocial development
at age three.
"While this study is limited to children age three and under, it clearly
demonstrates the importance of making treatment decisions based on a broad
range of outcomes and quality-of-life measures," said Lisa A. Simpson, M.B.,
B.Ch., M.P.H., AHRQ's deputy director.
Fluid in the middle ear -- otitis media with effusion (OME) -- is usually
associated with a mild to moderate hearing loss, which, although temporary,
has been thought by some health professionals to result in long-term
impairment of children's development. Approximately 280,000 children under
the age of three undergo tympanostomy each year, according to 1996 estimates.
Jack L. Paradise, M.D., and his colleagues at the Children's Hospital of
Pittsburgh and the University of Pittsburgh found that, in 402 of 588 children
in the study who developed persistent OME within the first three years, there
were no differences in the outcomes of speech, language, cognitive, and
psychosocial assessments. This was true for the children who were randomly
assigned to have tympanostomy surgery early as well as those who were assigned
to have the surgery only after their effusion persisted. Most of the children
in the early-surgery group received surgery within 60 days, whereas most in
the late-surgery group either received surgery after more than six months or
had not received surgery by age three. Infants up to two months of age were
enrolled in the study, which was conducted between May 1991 and December 1995.
On the General Cognitive Index of the McCarthy Scales of Children's
Abilities, the children in the early-surgery group tested at 99, and the
children in the late-surgery group tested at 101; both scores are in the
average range. On a test of the children's expressive language, the children
in the early-surgery group scored 124 while the others scored 126, which are
average scores. Other assessments used in the study are measures of receptive
language, sentence length, grammatical complexity, speech-sound production
(pronunciation), parent-child stress levels, and children's behavior. These
measures showed no significant differences between the two groups.
According to the researchers, these findings should not be applied to
children who have experienced OME for longer periods than those studied by the
researchers or to children with more severe degrees of hearing loss. Also,
they cautioned that the results of tests when the children reach ages four and
six years may differ from those found at age three.
In an accompanying editorial, James M. Perrin, M.D., Director, Division of
General Pediatrics and Center for Child and Adolescent Health Policy,
Massachusetts General Hospital for Children, and a member of AHRQ's National
Advisory Council, writes that "the study by Paradise, et. al., provides
evidence to support the use of a cautious approach in referring young children
with middle-ear effusion to receive tympanostomy tubes." He notes that "the
study by Paradise, et. al., provides no evidence that the insertion of tubes
improves developmental outcomes at the age of three years, although it does
decrease the persistence of effusion and reduce short-term hearing loss."
SOURCE Agency for Healthcare Research and Quality